Pregnancy: which probiotics are recommended?

Is it safe to take probiotics during pregnancy?

With a significant body of research now demonstrating their safety and efficacy, probiotics have finally become legitimate natural treatments for supporting not only gut microbiota balance, but even health in general, according to a growing number of scientists.

However, their potential use during pregnancy is still the subject of discussion, given the vulnerability of a pregnant woman and her unborn child.

In 2021, the authors of a meta-analysis suggested that probiotics could also be considered safe for pregnant women, though they encouraged further study and strict monitoring of their use in mothers-to-be (1).

In the case of pregnant women, we would always recommend consulting a health professional before taking any dietary supplements, probiotics included.

The most widely-studied probiotics in relation to pregnancy

The two probiotic species primarily studied for providing support to pregnant women are:

• Lactobacillus rhamnosus, a type of lactic acid bacteria found in dairy products, which is able to survive stomach acids by adhering to the intestinal epithelium to temporarily colonise the digestive tract. In the context of pregnancy, the specific strain Lactobacillus rhamnosus GG is being closely studied in order to confirm its possible effects on digestive discomfort, gestational excess weight and gestational diabetes (2-3). Lactobacillus rhamnosus GG is available as a dietary supplement (such as the probiotic product Lactobacillus Rhamnosus GG);
• Bifidobacterium lactis, another ‘friendly’ species which also has an excellent survival rate in the gut. Bifidobacterium lactis is also the subject of intensive study to evaluate its potential effects on pregnancy-related discomfort (4). This probiotic features in certain supplements, sometimes combined synergistically with other strains (one example is the probiotic formulation Probio Forte).

Let’s now take a closer look at the types of discomfort associated with pregnancy.

Constipation and probiotics in pregnant women

Constipation is common during pregnancy. It is characterised by fewer than three bowel movements a week and excessive straining when passing stools.

It affects almost 30% of women in the last two trimesters (5). There are at least three possible reasons: the amount of circulating progesterone, the physiological slowing of the food bolus through the digestive system, and compression of the bowel by the uterus.

Can probiotics help reduce constipation?

There are two theories as to why probiotics offer potential benefits against constipation. Firstly, they may make the gut more acidic, which would increase peristalsis (the muscle contractions that move food through the digestive tract). Secondly, several studies have shown the gut flora composition of those with constipation to be significantly different from that of normal-transit individuals.

The main species studied in relation to constipation in pregnant women are:

• Bifidobacterium lactis, as mentioned above (found in the probiotic formulation Probio Forte);
• Lactobacillus casei;
• and Lactobacillus acidophilus (6).

Gestational diabetes

As in type 2 diabetes, gestational diabetes is an intolerance to glucose: the body becomes unable to regulate blood sugar levels properly.

As this intolerance develops, it produces unpleasant symptoms (thirst, frequent urination, fatigue…) and more importantly, risks for the mother (Caesarean section or pre-term delivery, pre-eclampsia…) and for the baby (respiratory distress, neonatal hypoglycaemia, macrosomia (‘large for dates’)…)

Why are probiotics being studied for diabetes?

Scientists have found significant changes in the gut microbiota of those affected by gestational diabetes. These expectant mothers showed signs of inflammation, insulin sensitivity and adiposity similar to those seen in obese individuals. As a result, the scientific community is currently investigating which probiotics are most effective at restoring normal microbiota in this particular situation, in order to lower the risks posed by excessively high blood glucose levels. In terms of gestational diabetes, Lactobacillus rhamnosus GG and Bifidobacterium lactis are again the most prominent species (7-8).

Acid reflux, a common problem in pregnancy

Acid reflux is another common example of pregnancy-related discomfort, usually appearing after the 20^th week. It produces particularly unpleasant heartburn (pyrosis) in 80% of pregnant women, especially in the evening, after dinner.

Are there any probiotics recommended for acid reflux in pregnancy? In 2020, an analysis of 12 studies showed potential benefits from probiotics for acid reflux, more specifically against regurgitation and heartburn, though the conclusions were not definitive (9). Pending further progress in the field, pregnant women can already reduce their acid reflux by making some diet and lifestyle changes: eating slowly, having small meals throughout the day, and avoiding acidic foods and those that slow down gastric emptying.

Probiotics for post-partum depression?

Between 10% and 20% of new mothers suffer post-partum depression in the weeks following the birth of their baby.

Unlike the ‘baby blues’, this is a serious condition which can develop as early as the 6^th day post-delivery, and which requires urgent medical attention.

Potentially lasting several months, it can produce symptoms such as a loss of pleasure, profound sadness with no apparent reason, negative thoughts, etc.

Why are probiotics being studied for perinatal depression?

Recent research has shown that the body’s gut flora communicates with the brain via the vagus nerve and that it can produce neurotransmitters identical to those found in the brain such as GABA, serotonin and acetylcholine, all of which are involved in depression and mood disorders. Subsequent studies that have specifically investigated the effect of probiotics on depression, particularly post-partum depression, have identified the species Lactobacillus rhamnosus as, once again, showing the most promise (10).

Some synergistic formulations also combine other probiotics studied for their potential benefits for mental health (such as Lactoxira).

Any women who are breastfeeding should also consult a health professional before starting any supplementation.